Curriculum

The goal of our Internal Medicine Residency Program is to train leaders in healthcare by providing comprehensive and outstanding clinical training to our residents. Upon completion of training, physicians possess the knowledge, skills and attitudes necessary for successful practice of general medicine or further subspecialty training. These attributes for success include humanism, professionalism, clinical skills, management skills, and commitment to lifelong learning.

Categorical
The 3-year categorical Internal Medicine Residency Program exposes residents to a broad and balanced curriculum of inpatient and outpatient medical care.

Each year, residents assume increasing levels of responsibility. Faculty supervision emphasizes evidence-based clinical decision-making, appropriate resource utilization learning and the important role of the resident as teacher. Upper-level residents have considerable flexibility to design a schedule of rotations that meets their specific career needs.

Primary Care Track
With more medical students and residents choosing specialty medicine careers, a shortage of physicians practicing general primary care has been predicted. To address this expected shortage and to train residents interested in practicing general internal medicine after completing their internal medicine residency program, we created a Primary Care Track in 2012 within the categorical Internal Medicine Residency Program.

Residents in the Primary Care Track will;

Spend less time in electives/inpatient rotations to accommodate a month-long ambulatory care rotation in each year of the residency in one of our suburban primary care clinics

Be required to do one research project during the residency on a primary care topic of the resident’s choice; residents will be given extra time to work on their projects during their ambulatory months

Have additional in-depth training in subspecialties that are frequently referred to the primary care physician, such as wound care, urology, and podiatry

Have primary care mentors to help guide them in their choices for their general internal medicine career

Have the opportunity to enhance their didactic learning experiences by participating in an episodic Primary Care Journal Club and Ambulatory Morbidity and Mortality Conference

The Primary Care Track curriculum meets requirements of the ACGME for successful completion and graduation from the Internal Medicine Residency Program.

This Primary Care track does not have its own NRMP match number. Rather, two residents will be selected from each matched class prior to the start of the internship based on their desire and commitment to primary care. We may expand this program in future years.

Primary Care Track directors are Mary Lynn Sealey, MD, and Elizabeth Cuevas, MD. One of the chief residents will be designated as the primary care chief each year. The primary care chief has the responsibility to arrange schedules and didactic sessions during the ambulatory care month and to provide peer support for the Primary Care Track residents.

Preliminary
We offer 10 preliminary internal medicine residency positions per year. Preliminary residents are selected from among those applicants who intend to enter another field of medicine upon completion of this year, including:

Our program gives residents the opportunity to become great physicians by providing access to a diverse patient population presenting with a wide array of clinical conditions. Here are descriptions of the rotations for preliminary and categorical residents:

Core Rotations
Our core rotations are designed to cover the fundamentals of internal medicine residency while giving residents the opportunity to shape and augment their education with elective rotations. Core rotations are as follows:

General Medicine
During the general medicine rotation, residents gain knowledge of health promotion, disease prevention, diagnosis, and treatment. The population includes both genders from adolescence through old age, in health through all stages of acute and chronic illness.

On the general medical floors, each team consists of an attending, a PGY2 or PGY3 resident, one or two interns, and third- and fourth-year medical students. Interns and senior residents provide day coverage while the Night Medicine team provides overnight coverage.

Attending physician rounds are conducted at least 5 days a week. The attending physicians review the presentation and management of patients with the house-staff. In addition, the team discusses epidemiology, clinical manifestations, pathophysiology, diagnosis and evaluation, treatment, and prognosis of the medical conditions that affect their patients, incorporating relevant and recent literature in these discussions.

Intensive Care Medicine
Students will gain critical care experience in the AGH Medical Intensive Care Unit (MICU) with a team of six interns, three senior residents, a pulmonary-critical care fellow, and two attending physicians who round 7 days a week.

Interns and senior residents provide day coverage while the Night Medicine team provides overnight coverage. The pulmonary and critical care fellows provide 24-hour in-house coverage. The house staff take primary responsibility of managing critically ill patients, including performing most diagnostic procedures. All major management decisions are reviewed by the ICU medical team on daily morning rounds and evening rounds. During the ICU rotation, we teach trainees the following:

Techniques of resuscitation

Intubation

Respirator management

Bedside hemodynamics

Management of acutely ill medical patients

Senior residents also have the opportunity to rotate through the WPH medical ICU.

The CCU is staffed by three senior residents, an intern, a cardiology fellow, and a cardiology attending. The residents rotate between day and night shifts for overnight coverage. The cardiology fellows provide 24-hour in-house coverage.
During the rotation residents learn:

Ambulatory Care
Our program offers training in the outpatient setting, to prepare residents pursuing careers in primary care and outpatient based specialties. In our Medical Ambulatory Clinic (MAC), residents have the opportunity to deliver ongoing care to a group of patients in a setting similar to private office practice.

Utilizing the innovative 4:1 curriculum, we place our residents in many outpatient clinics throughout their residency. Each resident is assigned to a primary care site where they are exposed to the spectrum of primary care during their ambulatory weeks.

Each ambulatory week consists of 5 half days at the primary clinic and one half day of didactics. The rest of the week is spent rotating through many subspecialty clinics throughout the community.

We provide an educational portion of the ambulatory rotation through longitudinal lectures and online modules, along with the weekly ambulatory academic half day.

Hematology/OncologyUnder the supervision of an attending physician and a hematology/oncology fellow, two senior residents rotate through the hematology/oncology service each month. Our residents care for a wide spectrum of cases ranging from new diagnosis and treatment of acute leukemias to end stage metastatic disease. Clinical sites include the AGH Medical Oncology unit and the WPH Bone Marrow Transplant unit.

Night MedicineNight Medicine provides 24-hour resident coverage at AGH and WPH. The Night Medicine Rotation was designed to increase continuity of care for inpatients during nighttime while ensuring that residents do not exceed work hour mandates.

The night teams admit patients and provide cross coverage for the daytime teaching teams from 7 p.m. to 7 a.m. on Monday through Thursday nights and then attend morning report from 7 a.m. to 8 a.m. They then sign out to the primary day teams.

The night teams are supervised by an overnight attending at both sites.

Medical ConsultsThird-year residents perform house general medicine consults for a 4-week block. This elective exposes senior residents to pre- and postoperative inpatient management and ensures that residents develop expertise in the clinical and interpersonal skills essential to internal medicine.

Working closely with a core group of faculty, residents learn the general principles of preoperative risk evaluation and management. They:

GeriatricsThird-year residents do a 4-week Geriatrics rotation to gain insight into a key component of community practice. Residents on this rotation, with attending physicians, make house calls, round at nursing homes, and provide care in the geriatric clinic. Residents also spend time in the clinics focusing on:

Neurology
We offer extensive experience managing neurological disorders. Our Stroke Team, staffed by a neurology attending physician and second-year internal medicine residents, provides immediate care for all stroke patients. In addition, residents rotate through a neurology consultation service to learn to diagnose, evaluate, and treat common neurology problems in both the inpatient and outpatient setting.

Emergency Medicine
The AGH Emergency Department is staffed by residents from the Emergency Medicine, Surgery, and Internal Medicine training programs. On the Emergency Medicine rotation, first-year Internal Medicine residents have the opportunity to see patients with a variety of acute medical and surgical illnesses as the initial physician under the supervision of emergency medicine attending physicians. The objective of the rotation is to learn how to:

Approach emergency patients

Manage multiple patients

Recognize and triage ill patients

Manage patients acutely

Residents are also exposed to common ED problems.
Each resident has 15 shifts in a month.

Elective RotationsIn addition to the core rotations, our program supports professional development by offering distinct training pathways that allow residents to tailor the residency experience to meet their individual career goals. Whether residents want to sub-specialize, serve patients in a primary care setting, practice as a hospitalist or shine as a clinician researcher, our program prepares residents to reach those milestones. Available electives include:

Our innovative 4:1 rotation schedule provides the resident with the best of both worlds: a robust outpatient experience by enhancing continuity in the clinic experience while minimizing the outpatient duties of residents when they are on inpatient rotations. The benefits of the 4:1 schedule include:br />

Continuity of Care – You are never pulled off-service, rushing to sign out to leave the hospital for clinic. This improves your patient safety. The primary team will be in house (i.e., in the hospital) to triage acute events rather than letting a covering physician deal with acute problems while you’re at clinic.

Better Outpatient Experience – In the traditional system, a resident would have clinic for half a day once a week. Now there will be a dedicated week in which the resident will go to clinic Monday through Friday. There will be a better focus on the outpatient side. In addition, it gives the resident a “break” from the daily hospital life. During this time, the schedule is lighter but still demanding and challenging.

Staff Exposure and Teaching Modalities – In the traditional system, teams would be formed and expected to work cohesively until the one-month rotation was over. With the 4:1 schedule, there will be rotating team members. This will allow interns to see different teaching styles of different seniors and expose seniors to more of the intern staff. By doing so, this encourages more interaction among interns and senior residents making it a friendlier environment in which to learn.

Our major clinical training sites are Allegheny General Hospital, West Penn Hospital, and their associated faculty internal medicine clinics.

Allegheny General Hospital

Allegheny General Hospital (AGH), located on Pittsburgh’s north side, is a national leader in cardiovascular, cancer, neuroscience, orthopedics, and transplants. It offers a wide array of medical and surgical specialties and has a Level I Trauma Center and LifeFlight aeromedical transport service. It is one of the largest tertiary facilities in the region while upholding a commitment to excellence in patient care, medical education and research.

Allegheny General Hosptial Internal Medicine, one of our two continuity clinics, is located one block from AGH in the Federal North building—a state- of-the-art outpatient medical facility. Here residents work closely with preceptors in a firm system to ensure both quality patient care and an excellent clinical learning experience.

West Penn Medical Associates, located in the Cercone Building one block from West Penn Hospital, is our program’s other continuity clinic site. Residents scheduled for their clinic days here will work in a mini-firm system with a faculty preceptor, providing quality care to a diverse, adult population.

To ensure that our residents receive a thorough graduate medical education, we augment clinical experiences with various robust learning opportunities and educational resources designed to help them become excellent, knowledgeable, compassionate physicians ready for practice or subspecialty training. Our regularly scheduled didactic experiences are listed below.

Daily

Morning Report: Residents meet each day with the program director or a senior faculty member to review admissions from the previous evening. The setting is informal and discussion is focused on interesting cases and difficult patient management problems.

Core Curriculum Noon Conferences: Faculty members from all subspecialties actively participate in the Core Curriculum Noon Conferences lecture series. Lectures take place daily and attendance is mandatory for all residents on the inpatient service. Noon lectures cover a broad variety of topics from routine outpatient management to complex inpatient topics. All conferences are recorded for review by residents who are unable to attend.

Weekly

Board Reviews: Review sessions are held weekly to prepare residents for the ABIM certification exam. These sessions are for second and third year residents, with a different organ system reviewed each month. Board review is coordinated by the associate program director for education and is provided by AGH/West Penn faculty members. The Board Review program has been extremely well received by the residents and faculty.

Grand Rounds: This weekly conference covers a variety of broad topics in internal medicine with an emphasis on translational research. Lecturers include leaders in their fields from around the nation.

ICU Morning Reports: Once a week, an ICU resident presents a case. This is an interactive discussion with residents and subspecialists in pulmonary and critical care or cardiology. Core teaching points are emphasized in a short didactic session.

Intern Reports: The educational needs of interns differ from those of residents. In order to ensure excellence in intern teaching, each week the interns meet with Chief Residents for Intern Report. These one-hour sessions take the format of morning report and emphasize evidence-based medicine.

Monthly

Ambulatory Conferences: Once per month, during the ambulatory week, one half day is dedicated to ambulatory didactics. The day is divided into lectures, Yale cases and other didactic modalities.

Journal Club: Each month, a senior resident selects a journal article based on a clinical question and presents the study in a structured way for review. The goal is both to gain medical knowledge from the studies themselves and to improve the residents’ skill at reading and analyzing a scientific paper.

Morbidity and Mortality: Morbidity and Mortality Conference provides the basic structure for a broad performance improvement program that relates to multiple competencies, including medical knowledge, clinical skills, communication skills, system-based practice, and practiced-based learning. All internal medicine residents, including subspecialty attendings, fellows and all core faculty, attend the conference. The entire medical staff is invited to participate.

Our curriculum touches on all facets of medicine. It is a dynamic curriculum and is constantly being updated. Our goal is to engage our residents in active learning and to challenge them to become the best physicians possible.